Tuesday, September 27, 2011

PERSONAL BEST - By Atul Gawande

Thanks to Barry for passing this along.

Good coaches know how to break down performance into its critical individual components. In sports, coaches focus on mechanics, conditioning, and strategy, and have ways to break each of those down, in turn. The U.C.L.A. basketball coach John Wooden, at the first squad meeting each season, even had his players practice putting their socks on. He demonstrated just how to do it: he carefully rolled each sock over his toes, up his foot, around the heel, and pulled it up snug, then went back to his toes and smoothed out the material along the sock’s length, making sure there were no wrinkles or creases. He had two purposes in doing this. First, wrinkles cause blisters. Blisters cost games. Second, he wanted his players to learn how crucial seemingly trivial details could be. “Details create success” was the creed of a coach who won ten N.C.A.A. men’s basketball championships.

At Walton Middle School, Hobson and Harding thought that Critzer should pay close attention to the details of how she used coöperative learning. When she paired the kids off, they observed, most struggled with having a “math conversation.” The worst pairs had a girl with a boy. One boy-girl pair had been unable to talk at all.

Élite performers, researchers say, must engage in “deliberate practice”—sustained, mindful efforts to develop the full range of abilities that success requires. You have to work at what you’re not good at. In theory, people can do this themselves. But most people do not know where to start or how to proceed. Expertise, as the formula goes, requires going from unconscious incompetence to conscious incompetence to conscious competence and finally to unconscious competence. The coach provides the outside eyes and ears, and makes you aware of where you’re falling short. This is tricky. Human beings resist exposure and critique; our brains are well defended. So coaches use a variety of approaches—showing what other, respected colleagues do, for instance, or reviewing videos of the subject’s performance. The most common, however, is just conversation.

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Coaching has become a fad in recent years. There are leadership coaches, executive coaches, life coaches, and college-application coaches. Search the Internet, and you’ll find that there’s even Twitter coaching. (“Would you like to learn how to get new customers/clients, make valuable business contacts, and increase your revenue using Twitter? Then this Twitter coaching package is perfect for you”—at about eight hundred dollars for a few hour-long Skype sessions and some e-mail consultation.) Self-improvement has always found a ready market, and most of what’s on offer is simply one-on-one instruction to get amateurs through the essentials. It’s teaching with a trendier name. Coaching aimed at improving the performance of people who are already professionals is less usual. It’s also riskier: bad coaching can make people worse.

The world-famous high jumper Dick Fosbury, for instance, developed his revolutionary technique—known as the Fosbury Flop—in defiance of his coaches. They wanted him to stick to the time-honored straddle method of going over the high bar leg first, face down. He instinctively wanted to go over head first, back down. It was only by perfecting his odd technique on his own that Fosbury won the gold medal at the 1968 Mexico City Olympics, setting a new record on worldwide television, and reinventing high-jumping overnight.

Renée Fleming told me that when her original voice coach died, ten years ago, she was nervous about replacing her. She wanted outside ears, but they couldn’t be just anybody’s. “At my stage, when you’re at my level, you don’t really want to go to a new person who might mess things up,” she said. “Somebody might say, ‘You know, you’ve been singing that way for a long time, but why don’t you try this?’ If you lose your path, sometimes you can’t find your way back, and then you lose your confidence onstage and it really is just downhill.”

The sort of coaching that fosters effective innovation and judgment, not merely the replication of technique, may not be so easy to cultivate. Yet modern society increasingly depends on ordinary people taking responsibility for doing extraordinary things: operating inside people’s bodies, teaching eighth graders algebraic concepts that Euclid would have struggled with, building a highway through a mountain, constructing a wireless computer network across a state, running a factory, reducing a city’s crime rate. In the absence of guidance, how many people can do such complex tasks at the level we require? With a diploma, a few will achieve sustained mastery; with a good coach, many could. We treat guidance for professionals as a luxury—you can guess what gets cut first when school-district budgets are slashed. But coaching may prove essential to the success of modern society.

There was a moment in sports when employing a coach was unimaginable—and then came a time when not doing so was unimaginable. We care about results in sports, and if we care half as much about results in schools and in hospitals we may reach the same conclusion. Local health systems may need to go the way of the Albemarle school district. We could create coaching programs not only for surgeons but for other doctors, too—internists aiming to sharpen their diagnostic skills, cardiologists aiming to improve their heart-attack outcomes, and all of us who have to figure out ways to use our resources more efficiently. In the past year, I’ve thought nothing of asking my hospital to spend some hundred thousand dollars to upgrade the surgical equipment I use, in the vague hope of giving me finer precision and reducing complications. Avoiding just one major complication saves, on average, fourteen thousand dollars in medical costs—not to mention harm to a human being. So it seems worth it. But the three or four hours I’ve spent with Osteen each month have almost certainly added more to my capabilities than any of this.

Talk about medical progress, and people think about technology. We await every new cancer drug as if it will be our salvation. We dream of personalized genomics, vaccines against heart disease, and the unfathomed efficiencies from information technology. I would never deny the potential value of such breakthroughs. My teen-age son was spared high-risk aortic surgery a couple of years ago by a brief stent procedure that didn’t exist when he was born. But the capabilities of doctors matter every bit as much as the technology. This is true of all professions. What ultimately makes the difference is how well people use technology. We have devoted disastrously little attention to fostering those abilities.

A determined effort to introduce coaching could change this. Making sure that the benefits exceed the cost will take work, to be sure. So will finding coaches—though, with the growing pool of retirees, we may already have a ready reserve of accumulated experience and know-how. The greatest difficulty, though, may simply be a profession’s willingness to accept the idea. The prospect of coaching forces awkward questions about how we regard failure.

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